Provider Demographics
NPI:1003806662
Name:NIEHAUS, MICHAEL RICHARD (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:NIEHAUS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 VANCE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1575
Mailing Address - Country:US
Mailing Address - Phone:636-225-3700
Mailing Address - Fax:636-225-3709
Practice Address - Street 1:232 VANCE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-1575
Practice Address - Country:US
Practice Address - Phone:636-225-3700
Practice Address - Fax:636-225-3709
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000150484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health